Sternotomy closure using rigid plate fixation: a paradigm shift from wire cerclage.
Keith B Allen1, Kyle J Icke2, Vinod H Thourani3
1Saint Luke's Mid America Heart Institute, Kansas City, MO, USA.
Annals of Cardiothoracic Surgery
|December 4, 2018
Summary
Rigid plate fixation (RPF) significantly improves sternal healing and reduces complications after sternotomy compared to wire cerclage (WC). This innovative approach also enhances patient-reported outcomes and is cost-neutral.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Orthopedic Surgery
Background:
- Rigid plate fixation (RPF) is standard for fractures but less common for sternotomy closure, where wire cerclage (WC) prevails.
- A multicenter randomized trial compared RPF and WC for sternotomy closure.
Purpose of the Study:
- To evaluate sternal healing, complications, patient-reported outcomes, and costs of RPF versus WC for sternotomy closure.
Main Methods:
- 236 patients were randomized to RPF (n=116) or WC (n=120) across 12 US centers.
- Sternal healing assessed by CT scan at 3 and 6 months; complications and PROMs evaluated through 6 months.
- Health economic analysis conducted through 90 days and 6 months.
Main Results:
- RPF showed significantly better sternal healing scores and union rates at 3 and 6 months compared to WC.
- RPF resulted in fewer sternal complications (0% vs. 5%) and a trend towards fewer infections.
- Patient-reported outcomes (pain, function, quality of life) were numerically better with RPF; total costs were similar at 90 days and 6 months.
Conclusions:
- RPF closure after sternotomy leads to superior sternal healing and fewer complications.
- RPF improves patient-reported outcomes and is cost-neutral compared to WC.
- RPF represents a more effective sternotomy closure method than traditional WC.
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